Compression-Only CPR Increases Survival

Action Points

Note that in this study, the overall likelihood of survival to hospital discharge was higher among those receiving compression-only CPR than those receiving standard CPR. However, there was no difference in the proportion of survivors with good neurologic status.

Point out that American Heart Association and the International Liaison Committee on Resuscitation guidelines indicate that laypersons who are unable or unwilling to provide rescue breaths should be encouraged to provide compression-only CPR to individuals suffering out-of-hospital cardiac arrest. Note that new CPR Guidelines for 2010 will be released soon.

CPR using chest compression alone administered by bystanders to victims of cardiac arrest is associated with better survival than conventional CPR, a large prospective study found.

The five-year observational analysis of more than 4,000 out-of-hospital cardiac arrest cases found that patients were 60% more likely to survive when bystanders used the simpler hands-on method -- eliminating the need to interrupt chest compressions for mouth-to-mouth rescue breathing -- according to Bentley Bobrow, MD, of the Arizona Department of Health Services in Phoenix, and colleagues.

The prospective study of cardiac arrest outcomes in Arizona was undertaken after a public awareness campaign was begun in 2005 to improve "dismal" survival rates and increase knowledge of hands-only CPR, Bobrow and colleagues wrote in the Oct. 6 issue of the Journal of the American Medical Association.

And it appeared to work. Over the study period, the rate of bystander-administered CRP increased significantly -- and the number of cases in which compression-only CPR was used rose from less than one in five to three out of four cases, the investigators found.

The current study adds to increasing evidence that hands-only CPR is beneficial and it "really confirms the importance of minimizing interruption of chest compressions," Bobrow said.

The findings come just weeks after two large clinical trials reported that survival after both CPR methods was roughly equivalent.

For their study, Bobrow and colleagues analyzed 4,145 cases of out-of-hospital cardiac arrests between Jan. 1, 2005, and Dec. 31, 2009. Of those cardiac arrests, nonmedical bystanders gave conventional CPR in 666 cases, hands-only CPR in 849 cases, and no CPR in 2,900 cases.

Over the study period, the researchers found that the rate of any type of bystander CPR rose from 28.2% to 39.9% -- an increase that was significant at P<0.001 -- and the proportion of CPR using the hands-only method increased from 19.6% to 75.9%, a difference that was also significant at P<0.001.

Bobrow and colleagues also found:

The rate of survival to hospital discharge was 5.2% if no CPR was given, 7.8% for conventional CPR, and 13.3% for the hands-only method.

The odds of survival with conventional CPR were not significantly different from no CPR.

Compared with no CPR and conventional CPR, the adjusted odds ratios for survival with hands-only CPR were 1.59 and 1.60, with respective 95% confidence intervals of 1.18 to 2.13 and 1.08 to 2.35.

Overall survival increased from 3.7% in 2005 to 9.8% in 2009, a difference that was significant at P<0.001.

One implication of the study, Bobrow said, is that widespread public knowledge and use of chest compression-only CPR "could save thousands of lives a year."

He and colleagues noted it would have been impossible to randomize the study, since the decision of what type of CPR to use was left to the discretion of the bystanders.

To eliminate the potential for ascertainment bias, Bobrow added that EMS personnel were specifically trained in documenting the presence and type of bystander CPR.

The survival benefit seen in the study was "modest," noted an accompanying editorial by David Cone, MD, of the Yale University School of Medicine.

However, Cone wrote that the finding was important because survival after out-of-hospital cardiac arrest "has remained dismally low despite decades of study."

In his editorial, Cone also noted that standard CPR and compression-only CPR are currently considered equivalent by the American Heart Association and that new guidelines expected soon will concur -- and may even establish hands-only CPR as superior for nonmedical bystanders.

For professionals, though, conventional CPR will continue to have a place, Cone wrote, because airway ventilation is important for some victims of cardiac arrest.

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